Provider Demographics
NPI:1881662849
Name:WILSON, FAYE H (CRNA)
Entity Type:Individual
Prefix:
First Name:FAYE
Middle Name:H
Last Name:WILSON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 NW 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-1018
Mailing Address - Country:US
Mailing Address - Phone:305-585-1408
Mailing Address - Fax:
Practice Address - Street 1:1800 NW 10TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1018
Practice Address - Country:US
Practice Address - Phone:305-585-1408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2750982367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL307061100Medicaid
FL307061100Medicaid
FLG3794YMedicare ID - Type Unspecified